Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections.

Area of Science:

• Healthcare epidemiology
• Infection control
• Neonatal intensive care units

Background:

• Hospital-acquired infections, particularly bloodstream infections, pose a significant threat in neonatal intensive care units (NICUs).
• Central line-associated bloodstream infections (CLABSIs) are a major concern, leading to increased morbidity, mortality, and healthcare costs.

Purpose of the Study:

• To assess bloodstream infection (BSI) and CLABSI rates in New York State's 19 regional referral NICUs (RPCs).
• To identify variations in infection rates among these NICUs.
• To develop and promote best practices for reducing CLABSIs through a collaborative quality improvement initiative.

Main Methods:

• Data on bloodstream infections, patient-days, and central line-days were collected from 19 RPC NICUs during 2006-2007.
• Participating NICUs shared their results and collaborated to develop a central line-care bundle.
• The bundle was informed by site visits to high-performing NICUs and a review of existing literature.

Main Results:

• All 19 RPCs participated, contributing extensive patient-day and central line-day data.
• Nosocomial sepsis infection (NI) rates in 2006 ranged from 1.0 to 5.8 per 1000 patient-days.
• CLABSI rates in 2007 showed a six-fold variation, ranging from 2.6 to 15.1 per 1000 central line-days.
• A level-1 evidence-based central line-care bundle was unanimously approved by participants.

Conclusions:

• Substantial and highly variable rates of infections, morbidity, and resource use were observed across RPC NICUs.
• No participating center was entirely free of infections.
• The collaborative approach and accountability fostered by RPCs are expected to establish a network for performance monitoring and outcome improvement.